From the hospital, that is and you have been told to make an appointment with a specialist of sorts for your condition. For the most part these offices are usually very busy with other appointments and squeeze in's of their own and now you call for a appointment to see a physician for the first time and you cannot get one for another month. This is aggravating due to the fact that your symptoms persist from one illness in that now your disease or condition has become chronic. You need an appointment with a specialist who accepts your health insurance and you really cannot wait more than a few days. The problem becomes similar to medication coordination in that a physicians duty is to ensure that any patient who is taking medications or more than one, they need to make sure that they don't have any interactions or side effects that a patient may not be able to tolerate. Just like an appointment, a patient may be unable to wait a month or so to see a physician for a chronic illness. Hospitals administer treatment, they don't coordinate insurance care so that a patient can just call a specialist up to make an appointment and be seen, there are the health insurance factors and appointment availability issues. The is much the same for physician offices. If a physician does not accept an insurance plan then the patient must contact his or her health insurer to locate a physician nearby for their condition who accepts their health insurance. It's awful because the patient feels that way and the physicians offices are very busy, so is the front desk and the hospitals with people coming out just to have more come in. There needs to be a health care restructure of sorts to prevent gaps in medical treatment.

The standby physician specialist is another category of physicians who are well trained specialists in every area of medicine. These physicians will see a patient for example: neurology or cardiology in transition from the hospital until that patient can be seen by a specialist for routine evaluation. The standby physician specialist will accept every type of health insurance and can see a patient in an urgent care or health clinic setting. This will enable a patient to have his or her condition evaluated upon hospital discharge so that they can be prescribed treatment ect., so that thee is not a huge amount of time from the last hospital visit and into a specialists office. This will also eliminate subsequent hospital visits for the same conditions and symptoms a patient may be having because the chronic condition is now being treated by a specialist. The standby physician is the "interim" physician or specialist that only sees patients upon hospital discharge or ER visit, this is a way to coordinate health care for patients who have conditions and cannot wait another month to see a specialist. Physician's offices are full and many patients have needs that take up a considerable amount of time and yet I still don't know of any medical office that charges by the hour. The needs of the patient given their many problems and other situations usually take lots of time. Medical offices should not be penalized for already doing the job of accepting patients. There are so many hours in a day and in them you have as many patients as possible. The emergence of people in ill health or needing to be seen by a physician in a certain amount of time; should not be used to punish the front desk, physicians or otherwise due to their already overburdened compliance. When there arises a situation whereby many medical offices are not accepting certain health insurances and patients want a preference of physician, this certainly limits who a patient can see as a physician. Health insurance among other things has yet to bring together the gap of physician patient coverage, meaning what is had by the patient can be accepted by the physician and in a timely fashion. The standby physician specialist can be referred to a patient from the hospital or ER and utilized for an "interim" amount of time until the patient can find a physician that accepts their health insurance and an appointment that does not affect their condition by putting them back into the hospital.

Medicine has changed from years ago. Physicians would sometimes visit a sick patient in their home for the common cold or other virus if they were not well enough to see the physician in their office. Then things changed, gas prices went up, the distance it took to drive to each patients home and of course having to have that nurse or assistant with you who knew everything... well things sure do add up. In the old days physicians were not seen as strangers but more like community or family extensions. Yup, times have certainly changed, it's all foreign to many! Technology has enabled many physicians to do visits with patients who are at home and are unable to visit the physicians office. This is good for relatively minor problems that do not require an extensive exam or testing. But the problem with the elderly or handicapped still remains. Many of the elderly did not work during times of technology or it's advancement so to have them go to that apple or android app that allows the doctor to bluetooth in and access their vitals may be somewhat difficult to navigate. Of course if they have children or grandchildren they need to rely on them to be computer handy so that in the event of a problem with an elderly patient they can get help to the patients home immediately. I know people miss the old days and how things were much "simpler" back then. A phone call, a visit, a bill, some medicine and all was right in the world. It's difficult getting an elderly or even handicapped person to a physicians office even for minor problems that came become serious given their condition. Physicians should be required to have the in home access app, that installs on a phone or tablet that syncs up with a patient's app on his or her phone or tablet so that the patient can see the physician despite their location. For example. Dr. Physiciandoitall is bombarded by patients and elderly people who call and need exclusive access to his medical services. Mr100's son has called and demanded to see Dr. Physiciandoitall without an appointment as Mr100 has complaints of aches, chills and does not want to eat or do anything else. Dr. Physiciandoitall can't see Mr100 because he has patients scheduled, labs, tests and other pertinent patient information to review in a timely fashion. Dr. Physiciandoitall also has to get to the hospital to see patients there and he also has a family outing right after that he must attend. "How am I going to do all of this?" Dr. Physiciandoitall asked. "I'm one person, I need something greater, competent, trustworthy to help me with all of this crap." A front desk office worker angrily looked at Dr. Physiciandoitall and said, "You hired me and I really hate the sarcasm now moving along. You need to get that in home access app, you know the one I been telling you about." "And do what? I just learned how to text." he said. "Install it and then we will begin to have patients do the same on their phone and tablet devices." said the front desk office worker. "What is this about?" Dr. Physiciandoitall asked. "The in home access app allows the patient to talk with you confidentially so that privacy is not violated. You can discuss Mr100's problem with his son and then even talk with Mr100 himself. With the in home access app you can even do blood pressure and heart rate checks and you know look the patient over and most of all still get paid under the telehealth visit or even discuss results if they have already been to the ER or urgent care. You're already behind in your visits so if you could talk with some of them through the in home access app, you can do what needs to be done via telehealth and not worry about Mr100 because you will be able to get him the appropriate care he needs without compromising him by leaving his home. This will expedite your day and you can get to the hospital, which I know your rounds will be a lot faster than in the office, medical complexities-nope you won't be answering those and then home to your family outing." said the front desk officer worker. "So you mean I can see who I have here and the rest we can just arrange a chat?" asked Dr. Physiciandoitall. "Exactly, I been asking for divine intervention and we really don't hit it off here, this should not be Genesis to you by now. If you hurry you can see who you have scheduled and the others who are real involved with work can arrange some private time in a chat with you without waiting over an hour to see you and me being upset enough to put a zapper on your butt for the patient to press to remind you that they are still waiting to see you." said the front desk office worker. These people have careers and should be able to install the app without too much of a problem." Dr. Physiciandoitall thought and realized that this was all for the best. The in home access app, a way to see patients from home, I can record vitals and other patient info into my EMR and most of all patients who are not compliant with visits due to transportation issues and other problems can be contacted and their visits be done by telehealth via the in home access app, which is great for emergencies so that the patient can be immediately brought to the hospital despite being a no show for a physician appointment.

Working in an internal medicine and cardiology office is a lot of work. Physicians have specialties that they also practice medicine in and as a result the front desk people actually do two jobs during their day. But they don't get two paychecks, aw bummer! Anyways, an echo or echocardiogram is a sonogram of the heart that uses high frequency sound waves to produce images of the heart. These sound waves are then sent to an echo or ultrasound machine from the probe or transducer so that images and measurements can be taken of the heart's valves, atria, aorta and ventricles ect. The heart has several embryological structures as far as development goes. This can complicate a sound wave interpretation of heart imaging because the of the hearts unique structure and embryonic view of the heart via the sound wave. This imperfection of physician and machine or eventually physician vs. patient is nothing to be desired. Technology utilizes sound waves for diagnostic procedures of every sort and it usually takes many an echo or probably into the retirement practice of to be able to perfect the interpretation of a sound wave.

For example:

Some areas of The Right Atrium of the Heart are structured in development and can be interpreted with the following:

Crista Terminalis- with use of current sound wave technology it can be mistaken for a tumor or thrombus.Eustachian Valve- can be seen as a thrombus, intracardiac.Thebesian Valve, Chiari Network- can be confused with each other or can be seen as a fibirinous thrombus.Coronary Sinus, Persistent Left Superior Vena Cava- this can be seen as a cyst or cavity in the heart.Trabeculations, Pectinate Muscles, Right Atrial and Left Atrial Appendage- can be seen as thrombus.Ligament of Marshall- is sometimes also seen as a thrombus and as a result anticoagulant treatment is given to patients.

An area of The Right Ventricle of the Heart is structured in development and can be interpreted with the following:

Moderator Band- can be seen as a tumor or thrombus.

An area of the Left Ventricle of the Heart is structured in development an can be interpreted with the following:

False Tendons- these are not moderator bands since left ventricles do not have them.

Yes, cardiology is difficult and in providing a hand there needs to be more than two of them. Ok, you guessed it I don't like cardiology either. Strange how things just make me miserable and unhappy. One day video waves will be the in-thing and technology just needs to get there.

My job is exhausting. The phones, referrals, medications, appointments, cancellations, ekg's, holter monitors, labs and of course pre-certifications. You have to be very task minded to do what I do and to be a multi task player. Quite a few years ago I sent my resume to a fast food burger joint. they never responded, just flat lined on me. Should I be insulted? I was in my late 30's at the time, you know the out of work and no money and nobody was willing to hire me. I didn't think I was doing anything absurd. What would you do if you had to eat and provide for yourself? Of course these jobs do not pay living wages but at least it would be a paycheck until someone else was willing to employ me. Did I see this as humiliation? Funny you should ask that, you know that fast food chain has a clown! Now, I know that there are those who only like people like myself when it comes to serving food quickly and not making very much money but I am the least of folk you should be intimidated by, in terms of only providing jobs to without living wages as I earn this now at the job I currently work. But that's America, people so scared and intimidated that they reduce the place to third world living. To be honest, I would rather serve food if the salary which is not much of was the same rather than be be surrounded by a bunch of old needy cheeks who need wiping and have other yearnings that they stay closeted about. No, I'm not threatened, no I'm not humiliated. Many years ago you didn't need a conscious to deal with those who did not look like you. As a result you didn't have to have one. This went on from generation to generation as people who wanted a select type of folk to do for them, they didn't have a conscious about what they did to people and they didn't feel they had to have one. Not having a conscious is dangerous because people do things and will always find a way to see to it that they are correct about what they are doing. Now, I'm not saying that white America is the only guilty race in this whole thing, but they sure do create the foundation of inequality. Black America is unable to because we don't have the power to, and yes there are those of every creed, color, race and nationality that will do things without a conscious. In the days where things were not seen as inappropriate, disgusting, wrong, warped, bent or the old "We can put 'em to good use, stuff happened. Why? Because conscious was not associated with such as action. If I may say that people dislike having to have a conscious about something or many things because it affects life and they way we live it. I would say that this is correct. In that instance of conscious, desperation and the want to be closeted, beauty has been a curse to my people for as long as we can remember. Should I be humiliated? Not! Precertification for medications and procedures like echo's, stress echo's, nuclear and lexiscan testing ect., should be done through an EMR. It will allow of course permission to a note or other medical record that is signed off on to be sent to the administrator the insurance company utilizes for pre-certifications. For example. Sally Mileshoe needs a nuclear and has a medication that requires pre-certification. Her physician uses Cotton EMR. Cotton EMR allows a front desk medical worker to go to the precertifications tab and verify Sally Mileshoe's insurance. After being directed to the administrator Tothecore for precert, the front desk worker signs in and is then allowed to upload a signed note, ekg and other relevant information in addition to other information that may be requested for each exam. This precertification request is then kept on file in the Sally Mileshoe's EMR chart. The front desk worker can then refer to Sally Mileshoe's chart for Tothecore approvals or denials or if they request more information a physician can arrange a chat with a physician to physician reviewer through the EMR. What's good about this is that all information, transcription is kept on file in the patient's chart and it can assist not only front desk workers but physicians in obtaining precert without too much of a hassle. This precert through EMR also works the same way for medications, once the health insurance is verified the front desk worker can precert through the EMR because it will automatically select the portal for medication precert according to the health insurance administrator it uses for medications. Precertification through EMR is a way to keep all precerts and referrals done within an EMR and on file with the precert administrator. The "other way" or approach people use to arrange a cover up to that non or lack of conscious, is to find fault or generate guilt by way of blaming the victim because being closeted in all supremacy is more important than generating revenue. Why? Because beauty is a curse to people. Yes, folks from all ages, creeds and colors flock to the woolly haired clown, nobody called him nappy, ill dressed or even ill mannered, but they did eat however. Should I be humiliated?